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<!DOCTYPE html>
<html lang="zh-CN">
<head id="Head1" runat="server">
    <title>数据上传</title>
    <ControlBase:Base ID="ControlBase" runat="server" />
    <style type="text/css">
      textarea{
        width: auto;
      }
    </style>
</head>
<body>
    <ControlHeader:Header ID="ControlHeader" runat="server" />
    <ControlLeft:Left ID="ControlLeft" runat="server" />
    <div id="content">
        <div id="content-header">
            <h1>数据上传</h1>
        </div>
        <div id="breadcrumb">
            <a href="#"><i class="icon-home"></i>数据中心</a><a href="#" class="current">数据上传</a>
        </div>
        <div class="container-fluid">
            <div class="row-fluid">
                <div class="span12">
                    <div class="widget-box">
                        <div class="widget-title">
                            <span class="icon">
                                <i class="icon-th-list"></i>
                            </span>
                            <h5>数据上传</h5>
                        </div>
                        <div class="widget-content nopadding">
                            <form id="dataAdd-wizard" novalidate="novalidate">
                                <input type="text" name="EyeCheck_Than" style=" display: none;">
                                <div id="form-wizard-1" class="step">
                                    <h3 class="invoice-meta">一、视力健康相关因素</h3>
                                    <%=html %>
                                </div>   
                                <div id="form-wizard-2" class="step">
                                    <h3 class="invoice-meta">二、BRV 五位一体视功能检测单</h3> 
                                    <div  class="form-inline askForm-small">
                                        <div class="divLeft">
                                            <label class="divLeft askLabel-small">姓名：</label>
                                            <div class="divLeft control-group">
                                                <input type="text" class="validateClass input-small" name="Guest_Name" />
                                               
                                            </div>
                                        </div>
                                        <div class="divLeft">
                                            <label class="askLabel-small">出生日期：</label>
                                            <input  name="Guest_Birthday" class="input-medium dateInput" type="text" placeholder="格式：年-月-日">
                                        </div>
                                        <div class="top-pad iCheck-list askForm-small">
                                          <label class="divLeft askLabel-small">性别：</label>
                                          <ul class="inline">
                                            <input class="icheckVal" type="text" name="Guest_Sex" style=" display: none;">
                                            <li>
                                              <input value="男" type="radio" name="radio_Sex">
                                              <label for="Guest_Sex">男</label>
                                            </li>
                                            <li>
                                              <input value="女" type="radio" name="radio_Sex">
                                              <label for="Guest_Sex">女</label>
                                            </li>
                                          </ul>
                                        </div>
                                    </div>
                                    <div  class="form-inline askForm-small mar-bottom">
                                        <label class="askLabel-small">学校：</label>
                                        <input type="text" name="Guest_School">
                                        <label class="mar-left askLabel-small">班级：</label>
                                        <input type="text" name="Guest_Class">
                                        <label class="mar-left askLabel-small">住址：</label>
                                        <input type="text" name="Guest_Address">
                                    </div>
                                    <div  class="form-inline askForm-small mar-bottom">
                                        <label class="askLabel-small">联系电话：</label>
                                        <input id="isPhone" type="text" name="Guest_Phone">
                                        <label class="mar-left askLabel-small">孩子出生时母亲年龄：</label>
                                        <input id="isAge" class="input-small" type="text" name="Guest_MomAge">
                                        <label class="mar-left askLabel-small">孩子出生体重：</label>
                                        <input id="isWeight" class="input-small" type="text" name="Guest_BirWeight">
                                    </div>
                                    <div id="dataHTML">
                                      <h5 class="askForm-small">自觉症状：</h5>
                                      <div class="iCheck-list askForm-small">
                                        <ul class="inline">
                                          <input class="icheckVal" type="text" name="Check_Surgery" style=" display: none;">
                                          <li>
                                            <input value="视物模糊" type="checkbox">
                                            <label>视物模糊</label>
                                          </li>
                                          <li>
                                            <input value="近距离工作后视疲劳" type="checkbox">
                                            <label>近距离工作后视疲劳</label>
                                          </li>
                                          <li>
                                            <input value="畏光、流泪、对光敏感" type="checkbox">
                                            <label>畏光、流泪、对光敏感</label>
                                          </li>
                                          <li>
                                            <input value="近距离阅读后眼胀、头痛、眼球酸胀" type="checkbox">
                                            <label>近距离阅读后眼胀、头痛、眼球酸胀</label>
                                          </li>
                                          <li>
                                            <input value="字体有移动感" type="checkbox">
                                            <label>字体有移动感</label>
                                          </li>
                                          <li>
                                            <input value="看近后看远模糊" type="checkbox">
                                            <label>看近后看远模糊</label>
                                          </li>
                                          <li>
                                            <input value="视近有重影、复视" type="checkbox">
                                            <label>视近有重影、复视</label>
                                          </li>
                                          <li>
                                            <input value="注视不稳定、缺乏集中注意力" type="checkbox">
                                            <label>注视不稳定、缺乏集中注意力</label>
                                          </li>
                                          <li>
                                            <input value="长期抱怨视疲劳" type="checkbox">
                                            <label>长期抱怨视疲劳</label>
                                          </li>
                                        </ul>
                                      </div>
                                      <h5 class="askForm-small">用药史：</h5>
                                      <div class="iCheck-list askForm-small">
                                        <ul class="inline">
                                          <input class="icheckVal" type="text" name="Check_Medication" style=" display: none;">
                                          <li>
                                            <input value="散瞳药（短期）" type="checkbox">
                                            <label for="Check_Medication">散瞳药（短期）</label>
                                          </li>
                                          <li>
                                            <input value="散瞳药（长期）" type="checkbox">
                                            <label for="Check_Medication">散瞳药（长期）</label>
                                          </li>
                                          <li>
                                            <input value="长期使用抗组织胺类药（如息斯敏）" type="checkbox">
                                            <label for="Check_Medication">长期使用抗组织胺类药（如息斯敏）</label>
                                          </li>
                                          <li>
                                            <input value="类固醇类药（如地塞米松）" type="checkbox">
                                            <label for="Check_Medication">类固醇类药（如地塞米松）</label>
                                          </li>
                                        </ul>
                                      </div>
                                      <h5 class="askForm-small">病史：</h5>
                                      <div class="iCheck-list askForm-small">
                                        <ul class="inline">
                                          <input class="icheckVal" type="text" name="Check_Disease" style=" display: none;">
                                          <li>
                                            <input value="德国麻疹" type="checkbox">
                                            <label for="Check_Disease">德国麻疹</label>
                                          </li>
                                          <li>
                                            <input value="过敏史" type="checkbox">
                                            <label for="Check_Disease">过敏史</label>
                                          </li>
                                          <li>
                                            <input value="支气管哮喘" type="checkbox">
                                            <label for="Check_Disease">支气管哮喘</label>
                                          </li>
                                          <li>
                                            <input value="其他" type="checkbox">
                                            <label for="Check_Disease">其他</label>
                                          </li>
                                        </ul>
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">眼病史：</label>
                                          <input name="Check_Eye" class="input-xxlarge" type="text" >
                                      </div>
                                      <h5 class="askForm-small">视力康复史：</h5>
                                      <div class="iCheck-list askForm-small">
                                        <ul class="inline">
                                          <input class="icheckVal" type="text" name="Check_Rehabilitation" style=" display: none;">
                                          <li>
                                            <input value="物理训练" type="checkbox">
                                            <label for="Check_Rehabilitation">物理训练</label>
                                          </li>
                                          <li>
                                            <input value="按摩" type="checkbox">
                                            <label for="Check_Rehabilitation">按摩</label>
                                          </li>
                                          <li>
                                            <input value="针灸" type="checkbox">
                                            <label for="Check_Rehabilitation">针灸</label>
                                          </li>
                                          <li>
                                            <input value="眼贴" type="checkbox">
                                            <label for="Check_Rehabilitation">眼贴</label>
                                          </li>
                                          <li>
                                            <input value="营养素" type="checkbox">
                                            <label for="Check_Rehabilitation">营养素</label>
                                          </li>
                                          <li>
                                            <input value="其他" type="checkbox">
                                            <label for="Check_Rehabilitation">其他</label>
                                          </li>
                                        </ul>
                                      </div>
                                      <h3 class="h3hr">屈光检查</h3>
                                      <h5 class="askForm-small">原眼镜处方时间:</h5>
                                      <div class="form-inline askForm-small mar-bottom">
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">矫正视力:</label>
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <h5 class="askForm-small">现综合验光:</h5>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">矫正视力:</label>
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <h5 class="askForm-small">瞳距:</h5>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="mar-left askLabel-small">OU：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">推断色感视力:</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">裸视距：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OU：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">戴镜视距：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OU：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <h3 class="h3hr">视功能检查</h3>
                                      <div class="form-inline askForm-small mar-bottom">
                                          <label style="float:left;" class="askLabel-small">远水平隐斜:</label>
                                          <input style="float:left;" type="text" class="input-small" >
                                          <div class="iCheck-list askForm-small">
                                            <ul class="inline">
                                              <li style="margin-top:3px;">
                                                <input value="Von Greafe" type="checkbox">
                                                <label>Von Greafe</label>
                                              </li>
                                            </ul>
                                          </div>
                                      </div>
                                      <div class="form-inline askForm-small mar-bottom">
                                          <label style="float:left;" class="askLabel-small">近水平隐斜:</label>
                                          <input style="float:left;" type="text" class="input-small" >
                                          <div class="iCheck-list askForm-small">
                                            <ul class="inline">
                                              <li style="margin-top:3px;">
                                                <input value="马氏杆法" type="checkbox">
                                                <label>马氏杆法</label>
                                              </li>
                                            </ul>
                                          </div>
                                      </div>
                                      <div class="form-inline askForm-small mar-bottom">
                                          <label style="float:left;" class="askLabel-small">AC/A:</label>
                                          <input style="float:left;" type="text" class="input-small" >
                                          <div class="iCheck-list askForm-small">
                                            <ul class="inline">
                                              <li style="margin-top:3px;">
                                                <input value="梯度法" type="checkbox">
                                                <label>梯度法</label>
                                              </li>
                                              <li>
                                                <input value="计算法" type="checkbox">
                                                <label>计算法</label>
                                              </li>
                                            </ul>
                                          </div>
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">Worth 4-dot：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">立体视：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">方法：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">调节反应：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">负相对调节：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">正相对调节：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">调节灵活度：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OU：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">调节幅度：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OD：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OS：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">OU：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">调节近点：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">集合近点：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <h5 class="askForm-small">水平正负相对融像检查：</h5>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">远：</label>
                                          <label class="mar-left askLabel-small">BI：</label>
                                          <input type="text" class="input-small" > /         
                                          <input type="text" class="input-small" > / 
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">BO：</label>
                                          <input type="text" class="input-small" > /         
                                          <input type="text" class="input-small" > / 
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">近：</label>
                                          <label class="mar-left askLabel-small">BI：</label>
                                          <input type="text" class="input-small" > /         
                                          <input type="text" class="input-small" > / 
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">BO：</label>
                                          <input type="text" class="input-small" > /         
                                          <input type="text" class="input-small" > / 
                                          <input type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">同视机检查：</label>
                                          <label class="mar-left askLabel-small">同时视：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">融合视：</label>
                                          <input type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">立体视：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <h3 class="h3hr">视觉相关检查</h3>
                                      <h5 class="askForm-small">角膜K值：</h5>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">R：弧度</label>
                                          <input name="RetinaCheck_RadianR" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">屈光度：</label>
                                          <input name="RetinaCheck_DiopterUpR" type="text" class="input-small" > /         
                                          <input name="RetinaCheck_DiopterDownR" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">平均值：</label>
                                          <input name="RetinaCheck_AverageR" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">散光值及轴位：</label>
                                          <input name="RetinaCheck_AstigmatismR" type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">L：弧度</label>
                                          <input name="RetinaCheck_RadianL" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">屈光度：</label>
                                          <input name="RetinaCheck_DiopterUpL" type="text" class="input-small" > /         
                                          <input name="RetinaCheck_DiopterDownL" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">平均值：</label>
                                          <input name="RetinaCheck_AverageL" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">散光值及轴位：</label>
                                          <input name="RetinaCheck_AstigmatismL" type="text" class="input-small" >
                                      </div>
                                      <h5 class="askForm-small">A超值：</h5>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">R：AC</label>
                                          <input name="RetinaCheck_ACR" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">L：</label>
                                          <input name="RetinaCheck_LR" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">V：</label>
                                          <input name="RetinaCheck_VR" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">AL：</label>
                                          <input name="RetinaCheck_ALR" type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">L：AC</label>
                                          <input name="RetinaCheck_ACL" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">L：</label>
                                          <input name="RetinaCheck_LL" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">V：</label>
                                          <input name="RetinaCheck_VL" type="text" class="input-small" >
                                          <label class="mar-left askLabel-small">AL：</label>
                                          <input name="RetinaCheck_ALL" type="text" class="input-small" >
                                      </div>
                                      <div  class="form-inline askForm-small mar-bottom">
                                          <label class="askLabel-small">裂隙灯检查：</label>
                                          <input type="text" class="input-small" >
                                      </div>
                                      <h3 class="h3hr">双眼视功能诊断：</h3>
                                      <h5 class="askForm-small">AC/A值：</h5>
                                      <div class="iCheck-list askForm-small">
                                        <ul class="inline">
                                          <li>
                                            <input value="正常" type="checkbox">
                                            <label>正常</label>
                                          </li>
                                          <li>
                                            <input value="过高" type="checkbox">
                                            <label>过高</label>
                                          </li>
                                          <li>
                                            <input value="过低" type="checkbox">
                                            <label>过低</label>
                                          </li>
                                        </ul>
                                      </div>
                                      <h5 class="askForm-small">近视眼：</h5>
                                      <div class="iCheck-list askForm-small">
                                        <ul class="inline">
                                          <li>
                                            <input value="轴性" type="checkbox">
                                            <label>轴性</label>
                                          </li>
                                          <li>
                                            <input value="曲率性" type="checkbox">
                                            <label>曲率性</label>
                                          </li>
                                          <li>
                                            <input value="调节问题" type="checkbox">
                                            <label>调节问题</label>
                                          </li>
                                          <li>
                                            <input value="双眼视问题" type="checkbox">
                                            <label>双眼视问题</label>
                                          </li>
                                        </ul>
                                      </div>
                                      <h5 class="askForm-small">远视眼：</h5>
                                      <div class="iCheck-list askForm-small">
                                        <ul class="inline">
                                          <li>
                                            <input value="轴性" type="checkbox">
                                            <label>轴性</label>
                                          </li>
                                          <li>
                                            <input value="曲率性" type="checkbox">
                                            <label>曲率性</label>
                                          </li>
                                          <li>
                                            <input value="调节问题" type="checkbox">
                                            <label>调节问题</label>
                                          </li>
                                          <li>
                                            <input value="双眼视问题" type="checkbox">
                                            <label>双眼视问题</label>
                                          </li>
                                        </ul>
                                      </div>
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